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Objective To assess intraobserver and interobserver variability in ovarian volume and gray-scale and color flow index measurements using transvaginal, three-dimensional, power Doppler ultrasonography. Methods Eleven women (22 ovaries) were examined on day 8 of controlled ovarian hyperstimulation therapy, which was part of their in vitro fertilization treatment protocol. The patients were examined twice by the first observer and once by the second observer. The acquired volume datasets were analyzed using the VOCAL(TM) imaging program, enabling the assessment of ovarian volume, vascularization index (VI), flow index (FI), vascularization flow index (VFI) and mean grayness (MG). For these parameters the intraclass (intra-CC) and interclass (inter-CC) correlation coefficients, within-observer and between-observers repeatability coefficient (r) and limits of agreement were calculated. Results Both intraobserver and interobserver repeatability of ovarian volume measurements were considered very good with an intra-CC value of 1.00 and inter-CC value of 0.99, respectively. Also VI, FI, VFI and MG measurements were repeatable by a single observer, the intra-CC ranging from 0.82 to 0.91. The interobserver reproducibility was also good for VI, VFI and MG measurements (inter-CC values 0.73, 0.70 and 0.81, respectively), but for FI measurements the reproducibility was poor (inter-CC = 0.29, r = 7.87). Conclusions In general, the intraobserver reproducibility was better than interobserver reproducibility for all parameters. The volume assessments were reproducible both by one observer and by two separate observers. The intraobserver and interobserver variabilities were acceptable for VI, VFI and MG, whereas for FI the interobserver reproducibility was poor. Our results suggest that measurement of gray-scale and color Doppler flow indices is reproducible thus allowing them to be used in clinical practice and research. (Less)

Objective Effect of the side of ovulation on uterine, ovarian, and follicular blood flow parameters and various hormone levels. Design Prospective, observational study. Setting Fertility Clinic, St. George's Hospital. Patient(s) Nineteen women with regular menstrual cycles. Intervention(s) Pulsed Doppler measurements and serum hormonal concentrations during midfollicular, periovulatory, and midluteal phase for three successive cycles. Main outcome measure(s) Doppler blood flow and serum hormones. Result(s) Doppler blood flow of the ovarian stroma and follicular and uterine arteries showed no differences in the three phases between the right and left sides. Left-side uterine peak systolic velocity (PSV) (right-side PSV, 31.51cm/s; left-side PSV, 37.38 cm/s) during the periovulatory phase tended to be higher in the nondominant ovary; however, this was not quite significant. The serum hormone concentration showed no significant differences. Conclusion(s) The side of ovulation did not influence the Doppler blood flow to the ovarian stroma or follicular and uterine arteries. The side of ovulation had no effect on serum FSH, LH, 17β-estradiol, P, inhibin A, or inhibin B levels.

We present the case of a young woman with persistent secondary postpartum hemorrhage. Transvaginal imaging demonstrated an irregular pulsatile lesion in the anterior myometrium. Color Doppler analysis revealed the presence of abnormal vessels consistent with an arteriovenous malformation. Typically this vascular abnormality had a turbulent pattern of arterial and venous flow with high peak velocities and low resistance. The patient was treated with selective arterial embolization leading to a full recovery.

Domuztepe est situé au sud de la partie centrale de la Turquie entre les villes de Kahramanmaraş et Gaziantep. D 'une superficie d 'environ 20 hectares, Domuztepe est l 'un des plus grands établissements du 6e millénaire connu à ce jour. Les recherches ont porté sur les niveaux Halaf récent (Néolithique récent) qui se trouvent approximativement à 2 m de la surface et que les dates C14 permettent de dater entre ca. 5 700 et 5 450 ВС (cal.). Les résultats présentés ici concernent le large terrassement artificiel observé, la, fouille d 'un complexe élaboré de sépultures collectives ; et, pour les couches les plus récentes, le dégagement de structures architecturales les unes rondes, les autres rectililignes. Nous présentons en détail ce qui peut être mis en relation avec les rites qui auraient accompagné l'enterrement de 35-40 individus. Les ensembles céramique, glyptique et de pierre sont brièvement décrits et un aperçu de la paléo-économie est donné. En conclusion une discussion est proposée sur ce qui peut, sur ce site, suggérer l'émergence d'une certaine complexité de l'organisation sociale.

The value of diversity metrics to represent ecological communities and inform broad-scale conservation objectives and policy has often been subject to debate and uncertainty [1,2]. In practice, diversity metrics are important in setting management and conservation priorities, just as economic indices contribute to global monetary and financial policies. Thus, key challenges for ecologists are to identify new ways to view and summarise patterns in biodiversity and improve on the metrics available for management purposes. In a recent paper on functional diversity patterns in reef fishes [3], we highlighted the potential of new insights gained from functional trait-based approaches to inform marine management, stressing the need to develop and refine biodiversity measures that are linked to ecology (rather than taxonomy). We used a unique, fisheries-independent reef fish identity and abundance dataset, collected using standardised methods from equatorial to high latitude regions all over the world, to provide the first global view of the distribution of individuals amongst species (including a measure of evenness) and functional traits amongst marine communities. A recent paper by Robinson et al. [4] published in Marine Policy criticised the use of our evenness index as a measure of biodiversity, and questioned the use of functional trait-based metrics derived from surveys of standardised areas for decisions relating to broad-scale management of marine systems. In this paper we respond to Robinson et al. and rebut their claims related to sampling bias and broad-scale applicability of trait-based approaches.

Objective: To evaluate the effectiveness of adding outlet views to the four chamber view in routine prenatal ultrasound screening for major congenital heart defects (CHD) as performed by trained sonographers, and to compare the procedure with current practice. Design and setting: Prospective observational study at a London teaching hospital. Participants and methods: 9277 women booked at a single institution (80% had first trimester nuchal translucency measurement) due to have routine fetal cardiac screening using the four chamber and outflow tract views at > 18 weeks of gestation. Main outcome measure: Identification of major CHD in chromosomally normal and abnormal pregnancies antenatally or postnatally. Results: There were 40 abnormalities (4.3/1000), of which 30 were chromosomally normal (3.3/1000). The overall antenatal detection rate was 75% (95% confidence interval (CI) 59% to 87%) and 70% (95% CI 51% to 85%) for euploid pregnancies. Abnormal cardiac views accounted for 70% of all prenatal diagnoses, 30% of which were made at ≤ 18 weeks. The sensitivity of cardiac views during the first scan at > 18 weeks was 52%. Of all patients undergoing nuchal translucency screening, 34 had major CHD, nine with increased nuchal translucency (26.5%). Factors influencing the results of this screening programme were training and audit of operators, adequate equipment for antenatal examination, ease of access, and low threshold for referral to specialised fetal echocardiography. Conclusion: Adding ventricular outlet views to the four chamber assessment of the heart at routine fetal anomaly scans at > 18 weeks is the most effective technique to detect CHD prenatally. The success of such a programme depends on an infrastructure committed to continuous in house training of obstetric ultrasonographers coupled with feedback from specialised fetal cardiologists, as well as adequate resource allocation to obstetric hospitals involved with antenatal screening.

The Australian Curriculum, Assessment and Reporting Authority (ACARA) has been developing language-specific curricula for a range of languages in the Australian Curriculum: Languages and has also undertaken development of a Framework for Australian Languages, to provide guidance for the development of curricula for specific Australian Languages (Aboriginal languages and Torres Strait Islander languages) to accommodate the varied situations across Indigenous Australia. Foremost among the challenges for the Framework for Australian Languages is the multiplicity of languages potentially to be covered. It is estimated that there were some 250 Australian Languages at the time of the first sustained contact with outsiders. Of these only about 20 are still spoken 'right through'. The other languages are in various states ranging from minimal documentation and language use through to significant advances in language revitalisation (Walsh, 2001). Because there are so many languages, the framework is not, and cannot be, a language-specific curriculum. The learner pathways for the framework are: first language learner, language revival learner and second language learner. Typically the first language learner pathway will be for Indigenous students 'on country' in more remote parts of Australia. The second language pathway, on the other hand, will typically be learned 'off country' as is the case for Pitjantjatjara in places like Adelaide and other centres in South Australia quite distant from the Pitjantjatjara homelands. The largest array of languages is in the language revival learner pathway, which will most often be studied by non-Indigenous as well as Indigenous students. In this article we explore some of the framework's challenges in embracing the concept of Babel- from the Biblical story of the scattering of people across the earth and the 'confounding' of communication through the introduction of multiple languages. KEY WORDS Australian Curriculum, curriculum, curriculum development, Aboriginal languages, Torres Strait Islander languages, intercultural language learning, curriculum design, linguistic and cultural diversity [ILLUSTRATION OMITTED] THE FRAMEWORK FOR AUSTRALIAN LANGUAGES The Australian Curriculum, Assessment and Reporting Authority (ACARA) has been developing language-specific curricula for a range of languages, and has also undertaken the development of the Framework for Australian Languages (hereafter the Framework). This document will provide guidance for the development of curricula for specific Australian Languages. It therefore has been pitched at a high level of generality so as to be able to accommodate the varied situations across Indigenous Australia. One point of comparison might be to consider what a Framework for European Languages might look like: it would need to cover Finnish and French as well as German and Greek! The Framework has been designed so as to assist people in developing a language-specific curriculum for potentially any of the 250 Australian Languages. THE ECOLOGY OF AUSTRALIAN LANGUAGES Broadly speaking, it is estimated that there were 250 Australian Languages at first significant outside contact. Roughly 20 of these are still spoken 'right through' with the remainder in various stages of decline or revival (Schmidt, 1990, p. 1-2; Commonwealth of Australia, 2012, p. 34). In addition, for most languages there is dialectal variation which can be important for group identity and thus adds to the complexity of the overall linguistic situation (see, for example, Dixon, 2010). Particularly over recent decades there has been an extraordinary increase in language revitalisation activity (e.g. Troy & Walsh, 2010; Walsh, 2001). Some languages that had been written off are gaining new texts and new vocabulary. One such example is Butchulla from south-east Queensland for which a lullaby has been performed and written by the Aboriginal language activist, Joy Bonner (see https://open. …

OBJECTIVE: To determine ovarian blood flow characteristics using three-dimensional power Doppler ultrasound.METHODS: We examined 30 patients (30 cycles) prior to the start of their in vitro fertilization treatment in the late follicular phase using three-dimensional power Doppler ultrasound. The volume, vascularization index, flow index, vascularization flow index, mean grayness and the presence of the dominant follicle were determined for each ovary separately.RESULTS: The dominant follicle could be detected in 24 out of 30 cycles (80.0%). The volume of the dominant ovary was 9.9 (standard deviation, 4.0) cm3 and the volume of the non-dominant ovary 6.8 (standard deviation, 2.8) cm3 (P < 0.001). Mean grayness in the dominant ovary was 43.3 (standard deviation, 5.0) and in the non-dominant 47.2 (standard deviation, 4.0) (P < 0.001), but no other differences could be observed between dominant and non-dominant ovaries. The shell with a diameter of 2 mm surrounding the dominant follicle had a higher vascularization index (mean, 9.0; standard deviation, 5.9) and vascularization flow index (mean, 4.2; standard deviation, 2.8) than the whole dominant ovary (mean, 5.5; standard deviation, 2.5 and mean, 2.5; standard deviation, 1.3, respectively) (P = 0.003 and 0.002, respectively). In the cycles without a dominant follicle (n = 6), flow index (mean, 50.0; standard deviation, 5.9) and vascularization flow index (mean, 7.3; standard deviation, 6.2) on the left side were higher than on the right side (mean, 40.2; standard deviation, 3.1; mean, 1.5; standard deviation, 1.4; P-values 0.013 and 0.046, respectively).CONCLUSION: In the dominant ovary, the volume was higher and mean grayness lower than in the non-dominant ovary. The vascularization index in the shell surrounding the dominant follicle was higher than the average vascularization index in the whole dominant ovary. In addition, there were differences in the vascularization and flow indices between right and left ovaries, which may be related to the anatomical difference in the venous drainage between right and left ovaries. (Less)

From March 1998 to 1999, the spatial and temporal variation in shoot and abundance characteristics of the seagrass, Heterozostera tasmanica (Martins ex Aschers) den Hartog were examined in Westernport, an estuarine embayment in south-eastern Australia. Seagrass characteristics were investigated at three sites: Charing Cross; Crib Point; and Newhaven. In the north (Charing Cross), waters are highly turbid and subject to high nutrient inputs from catchment sources, while in the south (Newhaven) waters are primarily oceanic. Crib Point represents an intermediary region in water quality. Temporal patterns in shoot parameters (leaf weight per shoot, leaf and stem weight per shoot, number of clusters per shoot and leaf surface area per shoot) of H. tasmanica were highly site dependent and were generally 2–4-fold higher at Newhaven compared to Charing Cross; consistent with improved water quality from north to south in Westernport. Seagrass abundance parameters (above-ground biomass and shoot density) also differed between sites with 1–2-fold higher values at Newhaven relative to the other sites. Relationships between shoot and physico-chemical parameters indicate that light availability is the primary factor influencing the growth of intertidal H. tasmanica meadows in Westernport.

Purpose: To evaluate the characteristics of polycystic compared to normal ovaries using three-dimensional (3-D) power Doppler ultrasonography. Methods: We recruited 42 volunteers, all of whom were commencing IVF treatment. Each patient was examined in the cycle preceeding the start of drug therapy during the late follicular phase. If eight or more subcapsular follicles of 2–8 mm in diameter in one two-dimensional (2-D) plane were detected in either of the ovaries, the patient was categorized as having polycystic ovaries (PCO); otherwise the ovaries were considered normal. The parameters examined were volume of the ovary, vascularization index (VI), flow index (FI), vascularization flow index (VFI), and mean greyness (MG). In addition, the ovary was arbitrarily divided into cortex and stroma, and thereafter volume, VI, FI, VFI, and MG were calculated for these two regions. Results: Twenty-eight women had normal ovaries and 14 had PCO. The comparison between normal and PCO showed that as a group the PCO were larger, without any differences in VI, FI, VFI, or MG. In patients with PCO, the right ovary was larger than the left one. In patients with normal ovaries, FI was higher on the left side. Division into cortex and stroma revealed that there were no differences in cortical or stromal VI, FI, VFI, or MG between normal and PCO on either side. Conclusions: The ovaries defined as polycystic were larger than normal ovaries, but there was no difference in the echogenicity of the stroma between polycystic and normal ovaries. We were also unable to demonstrate that the polycystic ovarian stroma was more vascularized than the stroma in the normal ovaries.

The importance of the original motives for migration has often been asserted in the economics of migration literature, but direct measures of such motives have seldom been included in empirical models of immigrant outcomes. For the first time, I am able to directly identify work, student, family, and refugee immigrants in a large UK survey dataset. Using a sample of immigrants who have been in the country for at least five years, I show that original motives are strong predictors of employment, wages, and uptake of the native national identity. On employment and wages, I find that those who originally came as work or student immigrants are the most successful, while family immigrants do less well, and refugees fare the worst. On national identity, I find that those who originally came as refugees and family immigrants are the most likely to identify as British, while work and student immigrants are the least. My results provide new support for the predictions of the human capital model of migration in both the economic and cultural spheres, as well as for the recent 'cultural distance' model of national identity proposed by Manning and Roy. I suggest that the flexibility of the British national concept may usefully support multiculturalism, but that the pursuit of such abstract national adherence should not detract from efforts to cultivate social and economic inclusion among immigrants.

A large number of power delivery applications for optical fibers require beams with very specific output intensity profiles; in particular applications that require a focused high intensity beam typically image the near field (NF) intensity distribution at the exit surface of an optical fiber. In this work we discuss optical fiber designs that shape the output beam profile to more closely correspond to what is required in many real world industrial applications. Specifically we present results demonstrating the ability to transform Gaussian beams to shapes required for industrial applications and how that relates to system parameters such as beam product parameter (BPP) values. We report on the how different waveguide structures perform in the NF and show results on how to achieve flat-top with circular outputs.

Objective To evaluate the validity of self-reported hysterectomy against the gold standard of uterine visualisation using pelvic ultrasound. Design Prospective cohort study. Setting UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) based in 13 National Health Service (NHS) Trusts in England, Wales and Northern Ireland. Participants Between April 2001 and October 2005, 48 215 postmenopausal women aged 50–74 randomised to the ultrasound screening arm of UKCTOCS underwent the first (initial) scan on the trial. Interventions At recruitment, the women completed a recruitment questionnaire (RQ) which included previous hysterectomy. The sonographer asked each woman regarding previous hysterectomy (interview format, IF) prior to the scan. At the scan, in addition to ovarian morphology, endometrial thickness (ET)/endometrial abnormality were captured if the uterus was visualised at the scan. Outcome measures Self-reported hysterectomy at RQ or IF was compared to ultrasound data on ET/endometrial abnormality (as surrogate uterine visualisation markers) on the first (initial) scan. Results Of 48 215 women, 3 had congenital uterine agenesis and 218 inconclusive results. The uterus was visualised in 39 121 women. 8871 self-reported hysterectomy at RQ, 8641 at IF and 8487 at both. The uterus was visualised in 39 123, 39 353 and 38 969 women not self-reporting hysterectomy at RQ, IF or both. Validity, sensitivity, specificity, positive predictive value and negative predictive value of using RQ alone, IF or both RQ/IF were 99.6%, 98.9%, 99.7%, 98.9% and 99.7%; 98.9%, 98.4%, 99.1%, 95.9% and 99.7%; 99.8%, 99.6%, 99.9%, 99.4% and 99.9%, respectively. Conclusions Self-reported hysterectomy is a highly accurate and valid source for studying long-term associations of hysterectomy with disease onset. Trial registration International Standard Randomised Controlled Trial Number (ISRCTN)—22488978

Transmitting high power laser light through fiber optic cables has been used in industrial environments for years. Designing fiber optic cables for industrial environments requires robust solutions able to handle high power losses without compromise either to process quality or to safety. Internal water cooling, where the optical fiber is in direct contact with water, in combination with an efficient cladding mode-stripper the optical fiber cable has superior advantages handling high power losses. In this paper we will present recent power-handling data for the new series of the well-known standards QBH and QD (LLK-D) fiber optic cables launched by Optoskand. The new series are designed with a combination of materials and internal water cooling.

In line with global targets agreed under the Convention on Biological Diversity, the number of marine protected areas (MPAs) is increasing rapidly, yet socio-economic benefits generated by MPAs remain difficult to predict and under debate1,2. MPAs often fail to reach their full potential as a consequence of factors such as illegal harvesting, regulations that legally allow detrimental harvesting, or emigration of animals outside boundaries because of continuous habitat or inadequate size of reserve3,4,5. Here we show that the conservation benefits of 87 MPAs investigated worldwide increase exponentially with the accumulation of five key features: no take, well enforced, old (>10 years), large (>100 km2), and isolated by deep water or sand. Using effective MPAs with four or five key features as an unfished standard, comparisons of underwater survey data from effective MPAs with predictions based on survey data from fished coasts indicate that total fish biomass has declined about two-thirds from historical baselines as a result of fishing. Effective MPAs also had twice as many large (>250 mm total length) fish species per transect, five times more large fish biomass, and fourteen times more shark biomass than fished areas. Most (59%) of the MPAs studied had only one or two key features and were not ecologically distinguishable from fished sites. Our results show that global conservation targets based on area alone will not optimize protection of marine biodiversity. More emphasis is needed on better MPA design, durable management and compliance to ensure that MPAs achieve their desired conservation value., Development of the RLS data set was supported by the former Commonwealth Environment Research Facilities Program, whereas analyses were supported by the Australian Research Council, a Fulbright Visiting Scholarship (to G.J.E.), the Institute for Marine and Antarctic Studies, and the Marine Biodiversity Hub, a collaborative partnership funded under the Australian Government’s National Environmental Research Program.

Objective To determine uterine artery impedance using Doppler in the second and third trimesters at sea level and at high altitude. Methods Uterine artery resistance and pulsatility indices (RI and PI, respectively) were obtained by Doppler velocimetry from 242 women in Cerro de Pasco (4300 m altitude) and 200 women in Lima (sea level), all with normal singleton pregnancies between 14 and 40 weeks of gestation. Impedance indices at high altitude and sea level were compared using fractional polynomial regression analysis. Results Impedance to uterine artery blood flow was lower at high altitude than at sea level (for PI ratio Lima/Cerro de Pasco = 1.06; P = 0.011). If gestation bands were compared, the difference was significant up to 25 weeks. Conclusion At high altitude, pregnancy is associated with lower uteroplacental impedance than at sea level. This may reflect a compensatory mechanism of uteroplacental development to lower oxygen tension associated with altitude.Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

Background Ultrasound imaging of the fetal ductus venosus is becoming increasingly commonplace in clinical practice. The true anatomical relationships of the fetal umbilical and portal venous systems have not been clearly defined due to paucity of published data on the relevant anatomy. This has led to confusing terminology when describing the fetal umbilical, portal and hepatic circulations. The aim of the present study was to examine and document the anatomy of the umbilical, portal and hepatic venous systems and to propose a standardized nomenclature. Methods This was a prospective study on 11 fetuses obtained from medical termination of pregnancies between 14 and 19 weeks of gestation. The liver was microdissected to expose the branching pattern and anatomical relations of the umbilical, portal and hepatic venous systems. Results A wide L-shaped venous confluence at the terminal end of the umbilical vein, termed the portal sinus, was identified. The portal sinus was connected to the right and left hepatic lobes, by the right and left intrahepatic portal veins, respectively. The extrahepatic portal vein drained into the portal sinus just before the origin of the right intrahepatic portal vein. The ductus venosus, a branchless straight vessel, originated from the portal sinus and ascended steeply in the direction of the diaphragm. Numerous small vessels draining the liver converged into three main hepatic veins, which open into the subdiaphragmatic vestibulum. Conclusion Based on detailed sequential anatomical dissection and clear illustrations, the present study documents the anatomy of the umbilical, portal and hepatic venous systems. Taking into account the embryological origin of the vessels, a new anatomically appropriate and simplified nomenclature of these venous systems is proposed. In clinical practice, the consistent use of the suggested terminology would allow collection of comparable data between units and enable operators to be confident of which vessels they are sampling by Doppler ultrasound.

Objective To assess the intraobserver repeatability and interobserver reproducibility of Doppler flow velocity measurements of the uterine arteries in pregnant women between 10 and 14 weeks of gestation. Methods In this prospective study, Doppler velocimetric indices (maximum peak systolic velocity, end-diastolic velocity, peak systolic velocity/end-diastolic velocity ratio, pulsatility index and resistance index) were measured twice by the same trained observer in each uterine artery of 63 women. In 47 of these women, a second trained observer then repeated the measurements. In addition, both observers classified qualitatively the blood flow with regard to the presence or absence of an early diastolic notch. The coefficient of variation, intraclass correlation coefficients, within observer and between observers repeatability coefficient and Cohen's kappa coefficient were calculated. Results The best parameter in terms of repeatability and reproducibility in both uterine arteries was the resistance index with a low coefficient of variation and high intraclass correlation coefficient. The other parameters (pulsatility index, peak systolic velocity/end-diastolic velocity ratio, peak systolic velocity and end-diastolic velocity) performed poorly with high coefficients of variation on both sides. Agreement between the repeated observations (inter- and intraobserver) with regard to the presence or absence of an early diastolic notch was good. Conclusion Doppler velocimetry of uterine artery blood flow is technically feasible between 10 and 14 weeks of gestation. This study demonstrates that this technique is prone to measurement errors. Quantitatively, the resistance index appears to be the most repeatable and reproducible measurement at this gestational age. Qualitative assessment of the waveform morphology also shows high levels of intra- and interobserver agreement.Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

Objectives To determine impedance and velocity characteristics of the fetal circulation using Doppler ultrasound, at extremely high altitude (4300 m) in the Peruvian Andes compared to an ethnically similar population at sea level. Methods This was a cross-sectional study of 196 women resident at high altitude (Cerro de Pasco, 4300 m above sea level) and 196 women resident at sea level (Lima) with normal singleton pregnancies. Pulsatility index (PI), maximum velocity (Vmax) and minimum velocity (Vmin) in the umbilical artery, the descending aorta, the middle cerebral artery and the ductus venosus were compared between the two populations using fractional polynomial regression analysis. Results The PI was higher at high altitude than at sea level in the umbilical artery (regression coefficient = 0.112, P < 0.001), and not significantly different in the descending aorta, middle cerebral artery and ductus venosus. Vmax was lower at high altitude than at sea level in all three arterial vessels assessed; Vmin was lower in two: the umbilical artery and the descending aorta. The high-altitude/sea-level ratios for umbilical artery Vmax and Vmin were 0.93 and 0.82, respectively (P < 0.001 for each), the ratios for descending aorta Vmax and Vmin were 0.93 and 0.89, respectively (P = 0.003 and P < 0.001, respectively), and the regression coefficient for the middle cerebral artery Vmax was −2.844 (P = 0.003). There was no significant difference in the middle cerebral artery Vmin or in the ductus venosus Vmax and Vmin. Conclusions Despite the lower ambient oxygen at high altitude and an increase in umbilical artery PI, the fetal circulation does not exhibit a ‘brain sparing effect’. This and the overall decrease in blood flow velocities in the fetal circulation at high altitude may be due to the increased fetal hematocrit, which will result in increased blood viscosity. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

Objectives To confirm the hypothesis that isolated cardiac echogenic foci at the second-trimester anomaly scan do not influence our current calculation of risk of trisomy 21 in individual pregnancies, which is based on maternal age and nuchal translucency thickness at 11–14 weeks. Design Observational study in a fetal medicine unit. Methods In a general pregnant population undergoing first-trimester nuchal translucency screening, data from 239 singleton pregnancies with isolated cardiac echogenic foci at the second-trimester anomaly scan were compared with those of a control group of 7449 pregnancies with normal anomaly scans. Prevalence of trisomy 21 was determined in both groups. Following the anomaly scan, the individual risks of trisomy 21 were calculated by adjusting the previous risk based on maternal age and first-trimester nuchal translucency. We assumed that echogenic foci did not alter each individual risk calculation. The expected number of cases of Down syndrome in both groups was then calculated from the sum of probabilities of each individual affected fetus. The observed number of cases was compared with the expected number in both study and control populations. Results There was no statistically significant difference between the prevalence of trisomy 21 in the study group (no cases) and in the control population (three cases). From individual risk calculations, observing no cases of trisomy 21 in the study group was the most likely event if echogenic foci did not increase the risk of this chromosomal abnormality ( P = 0.62). Conclusion The finding of isolated echogenic foci at the time of the 20 week-scan does not significantly change the risks of trisomy 21 if background risk and previous nuchal translucency measurements are taken into account in the individual risk calculation. We suggest that no further adjustments to risk should be used. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

A case of prenatal diagnosis of an overgrowth syndrome at 30 weeks of gestation is reported. The diagnosis was suggested on the basis of increased fetal growth from 16 weeks onwards, advanced bone age, and characteristic facial features such as hypertelorism, broad forehead and small chin. The fetus presented at 12 weeks with a markedly increased nuchal translucency thickness and generalized skin edema, but normal karyotype. Serial ultrasound scans revealed brain abnormalities including mild unilateral ventriculomegaly and a cyst in the cavum septi pellucidi. The pregnancy was terminated at the parents' request at 32 weeks of gestation and postmortem examination confirmed the prenatal findings. This case demonstrates the possibility of prenatal diagnosis of early overgrowth syndromes and highlights the dilemma arising from the prenatal diagnosis of a non-lethal condition associated with an uncertain prognosis and poorly documented in utero.

Introduction Mild pyelectasis is a common finding and there is some debate as to its association with aneuploidy. The results of a large, prospective, multicenter study of mild pyelectasis designed to determine the incidence and association with aneuploidy in an unselected population are reported. Methods A large multicenter, prospective observational study of unselected fetuses with mild pyelectasis identified between 16 and 26 weeks' gestation in routine ultrasound departments. Results There were 737 fetuses with mild pyelectasis of which 12 had an abnormal karyotype. Pyelectasis was isolated in three fetuses with Down syndrome, but in one the mother was older (36 years). Conclusion These data confirm the fact that the presence of mild fetal pyelectasis increases the risk for aneuploidy, in particular trisomy 21. However, other risk factors should be considered before embarking on fetal karyotyping, as for most pregnancies complicated by isolated mild pyelectasis, risks of aneuploidy will remain small. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

IVF treatment, which involves ovarian stimulation, poses significant health problems such as ovarian hyperstimulation and is associated with a high incidence of multiple pregnancy and premature birth. In this paper, we demonstrate how natural cycle IVF is an effective and potentially cost-effective alternative treatment option for certain groups of infertile couples. The study was conducted in the Assisted Conception Unit at King's College School of Medicine, London. Fifty-two women with regular menstrual cycles whose partners had normal semen parameters were offered a total of 181 cycles of treatment (average 3.49 per couple). Life table analysis was used to calculate cumulative success rates after successive cycles of treatment. After four cycles, the cumulative probability of pregnancy was 46% with an associated live birth rate of 32%. To achieve maximal effectiveness, natural cycle IVF should be offered as a series of treatment cycles, for it is safer, less stressful and can be offered over consecutive cycles. Moreover, the avoidance of expensive drugs and reduced intensity of monitoring make natural cycle IVF less expensive than conventional treatment involving stimulation. We calculate that this treatment can be offered at approximately 23% of the cost of a stimulated cycle, suggesting that it may be a cost-effective alternative to conventional assisted conception techniques.

Objective To evaluate the effectiveness of nuchal translucency (NT) measurement in screening for major congenital heart disease (CHD) in chromosomally normal fetuses. Design A population based cohort study of all women having fetal NT measurement at 10–14 weeks of gestation in an unselected population over a 3-year period. The outcome measure was the identification of major CHD in chromosomally normal pregnancies either antenatally or postnatally. Results Major defects of the heart and great arteries were identified in 26 out of 7339 pregnancies (prevalence 3.5 per 1000 pregnancies). Out of 26 cases, only four (sensitivity 15.4%, 95% CI 4–35) were in the group of 258 pregnancies (3.5%) with increased NT of ≥ 2.5 mm. The prevalence of major CHD increased from 3.1 per 1000 for NT < 2.5 mm to 50 per 1000 for NT ≥ 3.5 mm (likelihood ratio of 14.1, 95% CI 4.2–47.9). The positive and negative predictive values for NT ≥ 2.5 mm were 1.6% and 99.7%, respectively. Conclusions The prevalence of major CHD in this study was 3.5 per 1000, suggesting that ascertainment of CHD in our study population was thorough. Fetuses with NT measurements ≥ 3.5 mm have a significantly increased risk of major CHD, and this identifies a subgroup of high-risk patients in whom early fetal echocardiography would be advocated. The low sensitivity of NT for major CHD in the general population, however, indicates that NT cannot be relied on as the sole or major screening tool for this condition as previously reported. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

The observed high biomass of fast-growing macroalgae in Port Phillip Bay (PPB), Aus- tralia is of concern and may represent a shift from perennial macrophytes (e.g. kelps and seagrasses) to a dominance by fast-growing macroalgae. This study examined the limiting and optimum external ammonium-nitrogen concentrations for the growth of 3 fast-growing macroalgae that dominate reefs in northern Port Phillip Bay, Australia. The relationships between growth and tissue nutrients and the capacity of these algae to assimilate, store and survive on nutrients was examined. Winter and sum- mer experiments aimed to determine the effects of tissue nutrient status on growth responses. An absence of any seasonal variation in critical N thresholds and N subsistence quotas in any of the spe- cies examined suggests that all species are able to tolerate low N availability. The utilisation of N reserves to support non-limited growth of Hincksia sordida (Clayton) and Polysiphonia decipiens (Montagne) was about 2- to 5-fold shorter in summer than winter, indicating potential N-limitation during summer. A high requirement for N by both H. sordida and Ulva sp. means that internal N reserves could support reduced growth for shorter periods compared to P. decipiens. Such high demands for N by H. sordida and Ulva sp. makes these taxa susceptible to N-limitation in summer, when inputs of N to coastal waters are low. Elevated nutrient inputs into PPB may allow these taxa to become nutrient-sufficient and colonise larger areas of nearshore reefs.

The term ‘virtual bronchoscopy’ describes the creation and evaluation of representations of the bronchial tree and surrounding structures using spatial information derived from imaging sources other than the bronchoscope itself. Initially, this referred to two-dimensional and later three-dimensional (3D) bronchial tree representations generated from computed tomography images. However, virtual bronchoscopy can now also be performed using data from magnetic resonance imaging (MRI). Several software options are available that can be used to generate accurate and realistic renderings of the bronchial tree 1–3 . Advances in imaging technology have led to vast improvements in fetal evaluation. Ultrasound examination is the primary method of fetal assessment because it is patient-friendly, effective, cost-efficient and considered to be safe 4 . MRI is generally used when ultrasound cannot provide sufficiently high-quality images. It offers high-resolution fetal imaging with excellent contrast that allows visualization of internal tissues 5 .I n this article we describe virtual bronchoscopy performed in a normal fetus that underwent MRI at 28 weeks’ gestation due to placenta previa with suspicion of placenta accreta. MRI examination was performed using a 1.5-T scanner (Siemens, Erlangen, Germany). The protocol involved a T2-weighted sequence in the three planes of the fetal body (HASTE; repetition time (TR), shortest; echo time (TE), 140 ms; field of view, 300–200 mm; matrix, 256 × 256; slice thickness, 4 mm; acquisition time, 17 s; 40 slices). In addition, we applied a 3D, T2-weighted TrueFISP sequence in the sagittal plane (TRUFI; TR/TE = 3.02/1.34; voxel size 1.6 × 1.6 × 1. 6m m 3 ; flip angle = 70 ◦ ; parallel acquisition techniques 2; acquisition time, 0.26 s) (Figure 1). The entire examination time did not exceed 20 min. The 3D MRI datasets were reconstructed to produce an interactive surface model of the fetal respiratory tract that could be viewed from any angle. Firstly, a 3D model of the fetal airway was created from the overlapping image layers generated by MRI using the software Mimics (Materialise, Leuven, Belgium), which allowed the surface of the airway to be delineated using contrast detection in the relevant areas of interest. The 3D model that was generated was exported using the standard triangular language file format and then converted into an OBJ file using the MAYA 3D modeling software (Autodesk, San Rafael, CA, USA) 6,7 . This program allows the virtual positioning of observation cameras while working with multiple on-screen windows. After the development of the 3D model, the software allows the user to determine the best positioned viewpoints for visualization of the 3D model (Figure 2) and also facilitates the adjustment of lighting parameters to improve contrast resolution. Using the navigation mode it is also possible to perform virtual bronchoscopy to visualize the upper respiratory tract from the pharynx downwards through the tracheobronchial tree (Videoclip S1) with a quality similar to that which could be obtained by videotaped bronchoscopy. We have demonstrated that MRI data can be used to create a 3D model of the respiratory tract in a normal fetus. We believe that this technique could become a useful tool for the assessment of fetal airway patency.

Objective The aim of the study was to evaluate the feasibility of three-dimensional power Doppler imaging (3D-PDI) in the assessment of the patency of the Fallopian tubes during hysterosalpingo-contrast sonography (HyCoSy). Methods Women attending the fertility clinic were offered a Fallopian tubal patency test as part of the initial investigation. Hysterosalpingo-contrast sonography using contrast medium Echovist was performed on 67 women. Findings on the two-dimensional (2D) gray-scale scanning and three-dimensional power Doppler imaging were compared. The first technique visualizes positive contrast in the Fallopian tube; the second demonstrates flow of medium through the tube. Results Contrast medium Echovist produced prominent signals on the 3D-PDI image. Free spill from the fimbrial end of the Fallopian tubes was demonstrated in 114 (91%) tubes using the 3D-PDI technique and in 58 (46%) of tubes using conventional HyCoSy. The mean duration of the imaging procedure was less with 3D-PDI, but the operator time which included postprocedure analysis of the stored information was similar. A significantly lower volume of contrast medium (5.9 ± 0.6 mL) was used for 3D-PDI in comparison with that (11.2 ± 1.9 mL) used for conventional 2D HyCoSy. Conclusion Color coded 3D-PDI with surface rendering allowed visualization of the flow of contrast through the entire tubal length and free spill of contrast was clearly identified in the majority of cases. The 3D-PDI method appeared to have advantages over the conventional HyCoSy technique, especially in terms of visualization of spill from the distal end of the tube, which was achieved twice as often with the 3D technique. Although the design of the investigation did not allow the side effects of the two techniques to be compared, the shorter duration of the imaging and lower volume of the contrast medium used suggested that the 3D-PDI technique might have a better side-effect profile. The 3D-PDI technique allowed better storage of the information for re-analysis and archiving than conventional HyCoSy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Following intracytoplasmic sperm injection (ICSI), approximately 60-70% of oocytes are fertilized and of these embryos, approximately 45% withstand in-vitro culture conditions to produce healthy blastocysts. The efficiency of implantation of 2-4-cell embryos selected at the pronuclear stage and that of blastocysts are comparable. However, prolonged selection of embryos in vitro (4-5 days), has been proposed to eliminate chromosomal abnormalities, more specifically those inherited by defective spermatozoa. This hypothesis is based upon the assumption that the paternal genetic contribution is indispensable for blastocyst development. Here we examine this hypothesis and suggest that phenotypic manifestation of paternal genomic abnormalities might not occur prior to implantation. In addition to the parent-of-origin effect during embryogenesis, blastocyst transfer may not prevent the inheritance of genetic defects involving 'male factor' loci.

A case of Binder syndrome was diagnosed at 21 weeks of gestation using two-dimensional and three-dimensional ultrasound. The first indication of any abnormality was a flattened fetal nose demonstrated in the mid-sagittal plane. Further ultrasound imaging showed the virtual absence of the naso-frontal angle, giving the impression of a flat forehead and small fetal nose. Suspected mild hypertelorism was also seen using transverse and coronal planes. Differential diagnosis of this condition is discussed.

It is argued in this paper that the output of translators working into English as a second language can be evaluated by means of examining their ability to translate certain critical structures. These claims are made on the basis of data-based research with the support of a cognitive theory about language processing during translation, and an analytical procedure that models the decision pathways of translators. In brief, it will be argued that in timed translation into English as a second language, certain critical structures can provide important data, which can assist in evaluating translation students and in syllabus design. Specifically, the structures of ellipsis and relative clauses appear to be critical cases. The paper begins with a discussion of the relevance and distinctiveness of translation into English as a second language (TRESL). A sketch of the underpinning theory is presented, followed by a study of translations by Arabic-English student translators. The paper ends with a discuss...

Background. To assess whether the gestation at which abnormal uterine artery waveforms disappear is related to birthweight and complications of pregnancy. Methods. A prospective study of outcome of pregnancy after a uterine artery Doppler screening program set in an inner city teaching hospital. One thousand five hundred and twenty-four consecutive women attending the Obstetric Department for a routine anomaly scan at between 19 and 21 weeks gestation had maternal uterine arteries assessed using color wave Doppler. Those women in whom the flow was deemed abnormal were recalled for a further scan at 24-26 weeks gestation. The main outcome measures were birthweight, gestation at delivery and incidence of pre eclampsia. Results. The women in whom the uterine artery blood flow was normal at 20 weeks had babies with significantly higher mean birthweight than those who normalized between 20 and 24-26 weeks gestation ('late normalizers') after adjustment for confounding factors; gestational age, maternal height,...

Objectives The aim of this study was to compare ultrasound fetal size at high altitude and sea level. Methods Three hundred and thirty-four women in Cerro de Pasco at 4300 m (14 100 ft) altitude and 278 women in Lima (sea level) were recruited to the study. Ultrasound fetal biometry was carried out between 14 and 42 weeks of gestation. Biparietal diameter, occipitofrontal diameter, abdominal circumference and femur length were measured and head circumference and estimated fetal weight were derived from these data. Two hundred and seventy-seven women (82.9%) in Cerro de Pasco and 216 (77.7%) in Lima had normal singleton pregnancies and certain menstrual dates. These women were selected for statistical analysis. Fractional polynomial regression analysis on gestational age was performed, controlling for maternal height and parity. Results Fetal biometry measurements were significantly smaller in Cerro de Pasco compared with Lima. When gestation bands were compared this effect was present from 25 to 29 weeks onwards, and was greater in the abdominal circumference than in the head circumference and femur length (ratios Cerro de Pasco: Lima, 0.96, 0.97 and 0.98, respectively). Estimated fetal weight was also significantly lower in Cerro de Pasco (ratio 0.88), as were birthweights (ratio 0.88). If the centiles derived from the Lima population were applied for Cerro de Pasco, 11.2% of all estimated fetal weights would be below the fifth centile, and 1.08% above the ninety-fifth. Conclusions These data suggest that at high altitude, all fetal biometry measurements follow a lower trajectory than at sea level. Specific biometry charts should therefore be used for obstetric ultrasound at high altitude. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Mallowan's excavations at Arpachiyah in northern Iraq in 1933 uncovered a Burnt House at the summit of the mound. Although the importance of the discovery has been recognized ever since as vital ev...

Summary Background Whether some benign ovarian cysts can develop into cancerous cysts is not known. If a large proportion of ovarian cancers arose in this way, it might be possible to remove the benign cysts in a screening programme before they became malignant. We used follow-up data from a cohort of 5479 self-referred women without symptoms, who participated in a ultrasonographic-screening trial for early ovarian cancer between June, 1981, and August, 1987. We assessed whether the removal of persistent ovarian cysts from these women was associated with a reduction in the expected number of deaths from ovarian cancer in the cohort as a whole. Methods The expected number of deaths from all causes, all cancers, and ovarian, breast, and colorectal cancers were calculated for the study cohort by the standard life-table method. The actual number of deaths and each cause were obtained and the proportional mortality ratio was calculated for each cause of death. Findings 5135 (95%) of the participants in the original trial were traced. During the screening, five of these women were found to have stage I epithelial ovarian cancer and 88 had benign epithelial ovarian tumours. The number of reported deaths from all causes (387 [50% of expected]), all cancers (221 [71%]), and ovarian cancer (22 [90%]) was lower than expected because of the “healthy-volunteer effect”. Proportional mortality ratios were 100% (by definition) for all cancers, 141% for breast cancer, 128% for ovarian cancer (95% Cl 87·7–187·6, p=0·19), 84% for colorectal cancer, and 48% for lung cancer. Interpretation The removal of persistent ovarian cysts was not associated with a decrease in the proportion of expected deaths from ovarian cancer relative to other cancers during follow-up. For population-based screening of healthy women without a family history of ovarian cancer, a screening test is required that is specific and sensitive to early malignant disease, and inexpensive.

Objective To investigate the effect of low-dose, slow-release aspirin in reducing the incidence and/or severity of pregnancy complications in women identified as high risk of developing problems associated with uteroplacental insufficiency, namely pre-eclampsia or delivering a small-for-gestational age (SGA) baby. Design A prospective, randomized management study. One thousand and twenty-two women of mixed parity underwent color flow/pulsed Doppler (CFPD) imaging of the uterine arteries at the time of the 17–23 week (mean 19.9) anomaly scan. Women who were screen positive were randomized to a control or treatment group. The treatment group was given 100-mg slow-release aspirin (Disprin CV) daily and followed up at regular intervals. Women in the routine group received routine antenatal care. Main outcome measures were pre-eclampsia and SGA

Current data demonstrate that angiogenesis in the ovaries and uterus is an essential component of both follicular and luteal phases of menstrual cycle, tightly correlating with the levels of bioactive substances such as hormones, growth factors and interleukins. Ultrasound is used principally to demonstrate follicular growth, a receptive triple layer endometrium and to exclude pathologies such as fibroids and ovarian tumours. However, the development of new technologies such as CDI, CPA, 3D-US, 3D-CPA is now set to expand the role of ultrasound in the assessment of the processes in the ovaries, uterus and early pregnancy. There is growing evidence that studies of peri-follicular vascularity will predict the development of a healthy oocyte and subsequently an embryo. Endometrial blood flow studies with conventional CDI and the newer techniques of CPA and 3D-CPA will be important in predicting endometrial receptivity. Ovarian stromal vascularity appears to correlate with vascular endothelial growth factor (VEGF) levels and high vascularity is associated with PCO and a risk of ovarian hyperstimulation syndrome. 3D-CPA may improve our ability to assess ovarian and endometrial vascularization and blood circulation, to diagnose tubal patency. Increasingly, 3D ultrasound is being applied to diagnose the pathology of early singleton and multiple pregnancies.

The notion of "difficulty " is of practical relevance to many of the stakeholders in the business of training and accrediting translators. This article proposes that difficulty can be tackled in terms of source text, translation task, and translator competence. Focussing on text difficulty, a case study is reported that shows that the source text can be an independent source of translation difficulty and that a substantial proportion of the items can be equally difficult to translate into typologically different languages. The study also highlights possible reasons for text difficulty at the level of lexis, and suggests that difficulty can be interpreted in cognitive terms, with the support of models of working memory and of language comprehension and production.Resume: Le concept de "difficulte" en traduction est d'une grande importance aux yeux de tous ceux qui s'attachent a la formation et a l'evaluation des traducteurs. Cet article se propose d'aborder cette notion par trois biais: le texte-source, la tâche du traducteur, et sa competence traductive. En rapport avec le premier point, une etude de cas montre que le texte-source engendre des difficultes intrinseques, independamment de leur traduction en des langues-cibles pourtant eloignees sur le plan typologique. Ensuite, l'etude essaie de specifier les difficultes de nature lexicale, suggerant qu 'elles peuvent s'interpreter en termes cognitifs, a l'aide des modeles de memoire pratique, et de comprehension et production linguistiques.

Objectives To evaluate first trimester pregnancy screening for fetal aneuploidy and congenital heart defects by maternal age and nuchal translucency measurement and screening for fetal aneuploidies and congenital heart defects by ultrasound in an unselected population. Design A prospective study. Setting Fetal medicine unit, St George's Hospital, London. Sample 4523 consecutive viable fetuses at 10–14 weeks with a crown–rump length between 38 and 80 mm were scanned transabdominally (93%) or transvaginally (7%). Methods Screening was performed by calculating the background risk from maternal age, gestational age and obstetric history, which was then adjusted with the nuchal translucency measurement in relation to crown–rump length (adjusted risk). Main outcome measures Measurements of crown–rump length and nuchal translucency thickness. An adjusted risk of > 1:270 was considered as a positive screening test. Pregnancy outcome was obtained through karyotyping, outcome questionnaires and examination of the newborn infants. Results Mean maternal age was 29.4 years and mean gestational age 12.2 weeks. Screening was positive in 230/4523 fetuses (5.1%), when the adjusted risk (mean 1:2649) was > 1:270. Fetal karyotype was abnormal in 23 (0.51%) cases, including twelve with trisomy 21, five trisomy 18, one trisomy 13, one trisomy 10, one monosomy X and two triploidies. For a false positive rate of 4.7%, the sensitivity of this test was 78% in detecting any fetal aneuploidy. Only one out of nine major congenital heart defects in this population was found within the 110 euploid fetuses with increased nuchal translucency thickness (> 2.5 mm). Conclusion Screening for fetal aneuploidy by maternal age and nuchal translucency measurement can be effective in an unselected population. However, our results do not support its effectiveness in the detection of cardiac abnormalities.

Objective: To compare the efficacy of transdermal glyceryl trinitrate and intravenous (IV) ritodrine as tocolytics. Methods: Two hundred forty-five women with preterm labor and intact membranes between 24 and 36 weeks' gestation were randomized to transdermal glyceryl trinitrate or intravenous ritodrine. Treatment was continued until contractions stopped or a maximum of 7 days. Glyceryl trinitrate was administered as a 10- or 20-mg transdermal patch. Intravenous ritodrine was administered according to nationally available guidelines. The primary outcome was prolongation of gestation expressed as a percentage of the time from entry to 37 weeks. Secondary outcomes were proportion of women who delivered the same day, next day, or within 7 and 14 days of entry, and by 32, 34, and 37 weeks. Analysis was by intention to treat. Results: Twelve women (5%) were lost to follow-up. Glyceryl trinitrate and ritodrine prolonged gestation by 74% of time to 37 weeks (difference glyceryl trinitrate-ritodrine 0%; 95% confidence interval (CI) −10%, +10%). There was no significant difference in the proportion of women receiving glyceryl trinitrate or ritodrine who delivered within the specified days from study entry or weeks of gestation; however, 42 women who received glyceryl trinitrate and 58 women who received ritodrine delivered by 37 weeks (difference −11%; 95% CI −24%, +2%). No serious maternal side effects were reported for ritodrine or glyceryl trinitrate. Conclusion: We found no overall difference between glyceryl trinitrate and ritodrine in the acute tocolysis of preterm labor but a suggested advantage of glyceryl trinitrate over ritodrine in reducing preterm delivery rate. The maternal side effect profile and treatment discontinuation rates were fewer for glyceryl trinitrate, suggesting it was a safer alternative to ritodrine.

The fifth millennium is a key period in the development of complex societies in the Near East. Domuztepe, situated in southeastern Turkey on the northwestern edge of the traditional heartlands of the Halaf, is one of the largest sites known from this period. The investigation of this large (20 ha), central site is providing new details of the organization of society at the site and its relationship with the surrounding environment. The settlement seems to have been a focus of long-distance exchange, with evidence for the manufacture and manipulation of status items. Stamp seals occur remarkably frequently and ceramics seem to have been used in a complex way, indicating shifting external relations over time. There is also evidence for economic intensification, notably the possible use of secondary products.

One comprehensive ethical framework that can be applied to cases of third trimester abortion is based on the following notion: patient trust depends upon physicians developing specific virtues and basing their professional actions on these virtues. One such virtue, as described by Dr. John Gregory in 1772, is sympathy for the distress of others that overcomes self-interest. This application of sympathy and desire to relieve suffering can justify late term abortion in some cases. The compassionate response to sympathy forwarded by Gregory, however, must be properly regulated by reason, as Gregory himself recognized. Thomas Percival (1740-1803), author of the classic text "Medical Ethics," charged physicians with uniting "tenderness" (Gregory's "sympathy") with "steadiness." This combination of virtues reoccurs in the contemporary work of bioethicists Edmund Pellegrino and David Thomasma. The intellectual component of compassion requires physicians to exhibit compassion towards their patients, and this includes fetal patients. Thus, third trimester abortion is only justified in cases where fetal abnormalities are associated with the certainty or near certainty of early death or of a complete absence of cognitive developmental capacity. Most anomalies fail to meet these criteria, and physicians must exhibit the virtues of self-effacement and integrity to make rigorous, clinical, ethical judgements and properly balance the interests of the pregnant woman and the fetus.

Objective: To explore the value of serum vascular endothelial growth factor (VEGF) concentrations during IVF cycles in predicting the risk of ovarian hyperstimulation syndrome (OHSS). Design: Prospective study. Setting: London Women's Clinic. Patient(s): One hundred seven women undergoing IVF. Mild OHSS developed in 10 women, moderate OHSS in 7, and severe OHSS in 3. Intervention(s): Serum VEGF concentrations were measured before treatment, after pituitary desensitization, and on the days of hCG administration, oocyte collection, and ET. Main Outcome Measure(s): Serum VEGF concentrations. Result(s): Serum VEGF concentrations were higher in women in whom OHSS developed. The increase in the VEGF concentration that occurred between the day of hCG administration and the day of oocyte collection (the "VEGF rise") was an important marker of OHSS. The VEGF rise was higher in women in whom OHSS developed. A higher VEGF rise predicted all cases of OHSS and moderate/severe cases of OHSS with a sensitivity of 100% and a specificity of 60%. A likelihood ratio test showed that adding the VEGF rise or the VEGF concentration on the day of oocyte collection to a regression model as a continuous variable to the number of follicles, the E 2 concentration, and the presence of polycystic ovaries significantly contributed to predicting the risk of OHSS. Conclusion(s): The results support the role of VEGF as an important nonsteroidal index of ovarian response. The VEGF rise may have an advantage over the E 2 concentration, the number of follicles, and the number of oocytes, which individually predict only 15%–25% of cases of OHSS.